Trump Administration Finalizes 340B Rebate Pilot
The Trump administration has approved eight drugmakers’ rebate plans for the 340B drug discount pilot program that kicks off January 1. The pilot covers a selected group of 10 drug products from eight manufacturers who have submitted plans meeting specific criteria approved by the Health Resources and Services Administration (HRSA). The covered drugs include Eliquis, Enbrel, Farxiga, Imbruvica, Januvia, Jardiance, Stelara, Xarelto and multiple Novolog and Fiasp products.
The program offers upfront discounts, but the administration wants to reform and bring greater transparency to the program to ensure it meets the intent of serving lower income Americans with discount drugs. Trump officials believe this will be accomplished with the greater scrutiny that will occur with retrospective rebates vs. upfront discounts.
Numerous studies conclude that the program does not meet the original intent and that hospitals and other facilities do not in fact lower costs for the lower income and instead pad margins with the discounts. Some studies show that drug prices at 340B qualifying hospitals are actually higher than at those who do not qualify.
The pilot comes at a time when the Congressional Budget Office (CBO) revealed that the 340B program has exploded into a multibillion-dollar subsidy for thousands of nonprofit hospitals, driving up healthcare costs for patients, contributing to the federal deficit, and delivering little measurable benefit to patients in need. The analysis shows 340B spending rose from $6.6 billion in 2010 to almost $70 billion in 2023. During that same time, brand drug spending across the rest of the market grew at just 4% per year.
The CBO says culprits for the surge in spending include hospital consolidation, the surge of contract pharmacies, upside-down incentives that allow pocketing of the discount and thereby incentivizing use of high-cost brand drugs, and a lack of basic transparency/reporting or requirement to pass savings on to patients.
Additional articles: https://www.fiercehealthcare.com/providers/hrsa-approves-8-drugmakers-plans-340b-rebate-model-pilot-program and https://www.healthcaredive.com/news/new-cbo-report-340b-ballooning-costs-congress-must-act-dan-crippen-cbo/804109/ and https://www.healthaffairs.org/content/forefront/340b-drug-pricing-program-capped-safety-net-grant and https://www.healthcaredive.com/news/340b-rebate-models-approved-hrsa/804370/
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#drugpricing #340b #hospitals #branddrugmakers
https://www.modernhealthcare.com/politics-regulation/mh-340b-rebate-pilot-abbie-merck-hrsa/
Trump Criticizes Dems For Rising Premiums
In a social media post from an alternative universe, President Trump slammed Obamacare and demanded Democrats “do something” ahead of a huge surge in Exchange premiums. “As I have said for years, OBAMACARE IS A DISASTER! Rates are going through the roof for really bad healthcare!!! Do something Democrats!!!” the president wrote on social media. Of course, the GOP (my own party) has come up with no credible alternative and did not fund any extension. The charge rings hollow.
In other news, a new briefer from healthcare policy group KFF discusses the costs, timing, and barriers of implementing work requirements under the budget reconciliation act.
Additional article: https://www.kff.org/medicaid/challenges-with-implementing-work-requirements-findings-from-a-survey-of-state-medicaid-programs/
#trump #exchanges #healthcare #coverage
https://thehill.com/homenews/administration/5582573-trump-democrats-obamacare-costs/?tbref=hp
Various CMS Medicare Rules Published
Despite the government shutdown, the Centers for Medicare and Medicaid Services (CMS) published a series of final Medicare rules for 2026. Among them are for Accountable Care Organizations (ACOs) and other fee-for-service (FFS) quality programs. The rule modifies the Shared Savings Program quality performance standard and other quality reporting requirements, including removing the health equity adjustment applied to an ACO’s quality score beginning in performance year 2026. Could this be a precursor for the same in Medicare Advantage (MA)?
CMS also finalized the physician payment rule proposed earlier. This includes a one-year increase of +2.50 percent for CY 2026 and an estimated +0.49 percent adjustment necessary to account for finalized changes in work relative value units (RVUs) for some services. CMS also finalized a -2.5% efficiency adjustment to select services to better recognize that some services are likely to become more efficient over time, as compared to time-based services like office visits or behavioral health therapy.
Additional article: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-final-rule-cms-1832-f-medicare-shared-savings and https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-final-rule-cms-1832-f
#medicare #ffs #rates
— Marc S. Ryan
